April 19, 2011

Type 2 Autoimmune - Say What?

That link is http://med.stanford.edu/ism/2011/april/engleman.html and in part it says:

Nearly all type-2 diabetes drugs marketed today are designed to control a patient’s high blood sugar levels — a symptom of the body’s inability to respond properly to insulin. However, the researchers found that anti-CD20, which targets and eliminates mature B cells, could completely head off the development of type-2 diabetes in laboratory mice prone to the disorder and restore their blood sugar levels to normal.

As I understand this release, and let me be clear - I don't understand it, T cells and B cells inflame fatty tissues. This results in fat cells growing so rapidly that they exceed their blood supply and begin to die. To clean up the dieing cells the immune system creates macrophages. This process of inflammation, dieing and clean up inhibits the remaining fat cells ability to respond to insulin.

The significance is that this suggest a new process for type 2, an autoimmune process. The study suggest treatments based on this autoimmune reaction that are new ways of addressing type 2, specifically an antibody called anti-CD20. This antibody is already approved for use in humans to treat some blood cancers and autoimmune diseases.

Daniel Winer, DM of Stanford says, “We are in the process of redefining one of the most common diseases in America as an autoimmune disease, rather than a purely metabolic disease.”

As regular readers may have guessed, mice were involved in the studies. How this translates to humans is an open issue. This statement warented it own paragraph in the relaease: "Despite the treatment’s effectiveness in mice, the researchers caution against assuming rituximab will work in humans with established type-2 diabetes."

I think the study authors took a bit of creative license here, because while inflammation can arise from a number of sources (such as when a person cuts themselves), but that is not necessarily the same as autoimmunity (or failure of an organism to recognize its own parts as "self", which allows an immune response against its own cells and tissues), rather it is an internal process gone awry, which is different from an innate inability for the body to recognize its own tissues. Having said this, the idea is quite intriguing because there are already anti-CD20 medicines on the market, and the thought of expanding the label for those to the type 2 population could make for interesting research. While not necessarily applicable to type 1B diabetes, the research does open the field to additional research which could be applied to type 1, as well as many other autoimmune diseases. Stay tuned for more ....

This may hold some promise but until they perform clinical trials on humans it is really hard to draw any conclusions. Until then exercise and a healthy eating plan are still the best medicine for diabetes.